Healthcare Provider Details

I. General information

NPI: 1245340942
Provider Name (Legal Business Name): ARIANNE MARIE KIRBY RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARIANNE MARIE COFFMAN

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY SUITE 600
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

2503 AMBER ORCHARD CT W UNIT 301
ODENTON MD
21113-3634
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6699
  • Fax:
Mailing address:
  • Phone: 410-353-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02390
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: